Operating room no place for a tantrum

September 06, 2006|SANDRA G. BOODMAN The Washington Post

The scenes are legendary and occur with disturbing frequency in the nation's operating rooms: doctors yelling at nurses or berating residents, and nurses sniping at their colleagues. Now a growing body of research suggests that such tantrums and insults negatively affect patients by impairing communication and teamwork and creating distractions that can lead to errors. The latest evidence involves a survey of 244 operating room personnel, including surgeons, anesthesiologists, nurses and technicians employed by a large, unidentified academic medical center. The study, published in the July issue of the Journal of the American College of Surgeons, was led by physician Alan Rosenstein, a vice president of the Voluntary Hospital Association, a consortium of nonprofit community hospitals. Disruptive behavior, he found, is common and most often committed by surgeons. What they did -- Rosenstein and his co-author posed 25 questions about the frequency and impact of disruptive behaviors in the operating room, and compared those answers against a national database of 4,000 medical workers who also had been quizzed about such behavior. All were asked about the impact of these behaviors on patient care -- including the likelihood that they might lead to errors. Staff members were also asked to describe specific incidents they had witnessed or in which they had been involved. What they found -- Seventy-nine percent of those surveyed said they had observed brutish behavior -- including abusive language, yelling, insults and occasionally physical violence -- and 19 percent said these actions had resulted in an adverse event. What they advocate -- Hospitals need to recognize the "prevalence and significance" of disruptive behavior, they write, and develop codes of conduct that apply to physicians as well as other staff members.